Abstract
BackgroundAdipose tissue has been identified as an endocrine organ secreting adipokines involved in metabolic and inflammatory pathways. Adiponectin, an anti-inflammatory adipokine, is reduced in sepsis. High Molecular Weight (HMW) adiponectin, the biologically most relevant molecule, has been investigated very little in human sepsis. Zinc-alpha2-glycoprotein (ZAG) is a novel adipokine and its expression in adipose tissue is positively correlated with adiponectin expression. It is not yet known whether ZAG has a role in sepsis. In this study we assessed levels of HMW adiponectin and ZAG during different stages of sepsis.MethodsA prospective observational pilot study was carried out on 21 septic patients. Serum samples were taken on day 1 and 2 post ICU admission and on day of discharge. Samples were analysed for total and HMW adiponectin, HMW/total adiponectin ratio, and ZAG. Results were correlated with clinical and metabolic data.ResultsThere were no differences in total adiponectin, HMW adiponectin and ZAG plasma concentrations between day 1 (admission) and day 2 of the sepsis episode. Compared to admission, a significant increase in total and HMW adiponectin and ZAG was observed on the day of discharge when clinical improvement had been achieved. There was also an increase in the HMW/total adiponectin ratio at that time.ConclusionsOur data demonstrate an increase in both HMW adiponectin and total adiponectin in patients who had clinically recovered from sepsis. The increase in HMW/total adiponectin ratio with improvement of the clinical condition suggests that HMW adiponectin may have a greater role in the inflammatory process and insulin resistance seen in sepsis. In this pilot study, we have also demonstrated a significant increase in ZAG in critically ill patients temporally related to recovery from sepsis.
Highlights
In the last 15 years, white adipose tissue (WAT) has been identified as a sophisticated endocrine organ secreting adipokines with a myriad of different functions including involvement in metabolic, inflammatory and proliferative pathways [1]
Biochemical and haematological markers (White cell count and C-Reactive Protein (CRP)) were elevated and most had a degree of renal impairment. 9 of the 21 patients had to be started on renal replacement therapy for acute kidney injury
There was no significant correlation between High Molecular Weight (HMW) adiponectin and APACHE Acute physiology and Chronic Health evaluation Score (II) score
Summary
In the last 15 years, white adipose tissue (WAT) has been identified as a sophisticated endocrine organ secreting adipokines with a myriad of different functions including involvement in metabolic, inflammatory and proliferative pathways [1]. Zinc-α2-glycoprotein (ZAG) have been proposed as potential anti-inflammatory mediators released from WAT [1,2]. Expression and secretion of ZAG by human adipocytes is suppressed by macrophage-derived factors and TNF-α, paralleling release patterns for adiponectin [5]. Zinc-alpha2-glycoprotein (ZAG) is a novel adipokine and its expression in adipose tissue is positively correlated with adiponectin expression. It is not yet known whether ZAG has a role in sepsis. In this study we assessed levels of HMW adiponectin and ZAG during different stages of sepsis
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